Objective: To describe a structured multidisciplinary (MDT) pathway for patients with suboptimal outcomes following Deep Brain Stimulation (DBS), and to propose a framework transferable to other DBS centres.

Background: While DBS is an established therapy for Parkinson’s disease (PD) and dystonia, approximately 10% of patients experience persistent symptoms despite multiple programming and medication adjustments. Management of these complex cases is often inconsistent and lacks a systematic approach. We propose a multidisciplinary pathway to address this challenge.

Method: We established a dedicated MDT clinic comprising a DBS neurologist and neurosurgeon, with the patient and family present. Patients with PD or dystonia and suboptimal benefit despite extensive DBS adjustments and medication reviews were referred from routine clinics. The pathway integrates structured motor assessments (ON/OFF medications and DBS), neurosurgeon-led expert lead localization, and thorough review of historic DBS and medication adjustments, to inform on image-guided re-programming, and medication review.

Results: Twenty-eight patients (PD: 18; dystonia: 10) were assessed. Sixteen (57%) patients were managed with DBS adjustment alone (PD: 8; dystonia 8). Seven patients (39%) with PD required medication review: four patients had oral medication adjustments and three were referred for infusion therapies. Suboptimal lead positioning was identified in five cases (PD: 3; dystonia: 2). Of the PD patients, one underwent lead revision surgery and two have been referred for surgical re-evaluation. Of the dystonia patients, one declined lead revision and one has a dystonia plus syndrome and is awaiting additional investigations to determine aetiology prior to considering further intervention.

Conclusion: A structured MDT pathway provides a practical framework for the evaluation of DBS patients with persistent symptoms. This model helps determine whether DBS therapy can be further optimised and assists in identifying patients who may benefit from alternative strategies including oral medication adjustments, infusion therapies, or surgical revision. By supporting structured decision-making, this approach facilitates more individualised management of complex DBS cases.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-structured-multidisciplinary-pathway-for-the-management-of-complex-patients-following-deep-brain-stimulation/